Integrity

The Canadian Medical Protective Association (CMPA) (2009) states that physicians (and health care providers) have “…a duty to their patients to keep records that are accurate, complete and up-to-date” (p.9); Hence, the integrity of the data and the process by which this data is entered into the EHR is compromised when erroneous information is found and not corrected (CMPA, 2009).

As noted in the animation, the nurse validates the lack of integrity of the information compiled within the EHR, as she states that incorrect data – such as the patient’s blood pressure - may accidently be entered into the system. As well, the nurse initially is quick to assume that the information regarding urinary incontinence must be correct, despite the patient’s refusal and then afterwards, realizing that the wrong patients’ data is being discussed. According to Simpson (2005), there is a tendency to assume what is in the computer is correct. CMPA (2009) also asserts that if it is noted by a HCP that information on an EHR is incorrect, the HCP must notify other users of the EHR. All erroneous information should be corrected as soon as possible.

In the animation, the nurse makes no notation of ensuring that the information ought to be corrected, nor does she state that she will follow up with having the information corrected after the visit. Layman (2008) reported studies reviewed indicated variable rates of data accuracy within electronic health records.

I think its a misconception that Electronic Medical Records present different privacy, security or integrity issues than paper records. The reality is that the privacy and security issues are compounded by the increase in accessibility. Conversely that increase in accessibility is also the argument leading the push for integrated EMR and EHR. It is the ability to share information widely and in real-time that draws us to its creation. Instantaneous allergy and medical information will undoubtedly save lives... Carelessness with data collection (which occurs on paper too) is not resolved with the creation of an EMR, its effects are more widely felt and can potential cause more damage... Good argument for not assuming anything is correct. Clinicians must view all information critically and base decisions on the condition of the patient as well as the information they read.

I have actually seen the opposite effect of that noted by Simpson (2005), in that on more than one occasion I have been asked by staff to supplant Welch-Allyn electronic monitors with standard hand-pumped sphygmomanometers. When queried as to rationale, staff will advise that they "don't trust the machine." While not computers per se, I have observed this phenomenon with electronic thermometers as well -- if an unusual reading is obtained, it is attributed to the device as readily as it is to a physiological factor.

Trish

As to the variable rates of data accuracy entered into electronic records reported by Layman (2008), we should not be surprised. All forms of data entry will reflect human error rates -- a good reason for always viewing data outliers with a skeptical eye until replicated.